- Skype us and we will record your statement (skype id: bobbyramakant ). To schedule skype appointment, email: somya@citizen-news.org

- Tweet us! use #tag: #AIDS2012

- Have your say on our CNS Facebook page!

- Call us and record your statement! (+91-98390-73355)

SUMMARY:

The summary of this online consultation will feed into the issue brief which the onsite CNS team will use to provide issue-based coverage from AIDS 2012. The CNS team members and partners will also raise key issues highlighted by this consultation process at the AIDS 2012 in appropriate sessions.

TIMELINE:

The online consultation is open for five weeks (Tuesday, 5th June 2012 to Saturday, 7th July 2012), after which a summary report will be published by CNS.

5 comments:

In general vaccines will induce protection in general population and can have a huge impact on the overall incidence of TB in a population. So this means that there will be less transmission of TB among individuals. And if less people get infected there will be lower chance of co infection of HIV and TB. Hence there is more impact on the general incidence and transmissibility of TB. There is a very rich pipeline of vaccines to be used in children, adolescents and adults to boost the previous BCG vaccine. Two of them are boosting vaccines aiming to boost a previous immunization by BCG. They are so far in phase IIB of the proof of concept trial and if they prove to be successful then they can be tested in phase III clinical trials in the coming years and then maybe available by 2020. The boosting vaccines are subunit vaccines and hence safe for HIV+ children. Then there are new recombinant BCG vaccines being developed which are much more attenuated than the current BCG and are safe in HIV+ children. There are also vaccines that are focussing on replacing BCG, so these are priming vaccines can be used in neonates and young individuals and these are now in clinical phase II. What we are eventually looking for in the future is to find vaccines that would directly block the transmission of TB among individuals, and thus directly prevent TB-HIV co-infection.

In our country TB is endemic while HIV is not endemic. But there is a relationship between the two: TB patients are more prone to get HIV and vice versa. They have to be treated in a separate way as far as programme management is concerned.There is no single preventive product for HIV. There have to be several tools available- microbicides, vaccines, male circumcision, and better use of male and female condoms. America did not wait for microbicides and vaccines. When there was a big epidemic of HIV-AIDS in 80’s they turned the tide by effective use of barrier preventive products like condoms and safe sex practices. These two can do the task themselves. In India, our healthcare delivery system has to be energised. If you cannot ensure proper and widespread use of barrier methods like condoms how can you ensure the effective use of new microbicides. So the lesson home is to improve the implementation of existing technologies, increase effectiveness of existing technologies and then work for newer technologies. All vaginal and rectal microbicides are still in very early stage of clinical trials--Phase I and II. It will take at least 7-9 years before we can have an effective microbicide for vaginal use. For rectal microbicides it may take a little longer (10-12 years) because of the different patho-physiology and anatomy of rectum. In India non HIV STIs are more of a problem like STV and cervical cancer and about 3 million people are supposed to be suffering from them. So better control of trans infections like STVs is more essential to prevent HIV in the country.

Safe and effective microbicides will give women the power to protect themselves in a way that does not involve their partners and this is going to bring a dramatic change. It is important that microbicides be produced in contraceptive as well as non contraceptive forms so that women who want to become pregnant can still be able to protect themselves. Right now most of the candidates that are being examined include anti retro viral drugs. But women who are HIV+ will not be able to use ARV based microbicides because of the risk that it would interfere with their treatment regimen if they are on treatment or in the fear that it could cause drug resistance. So non ARV based microbicides will be very important for women who are living with HIV but who need to use a microbicide to protect a partner and also to protect themselves from a secondary infection of the virus. For an ARV based microbicide, a woman has to be sure that she is HIV- before being able to use it. A rectal microbicide would be useful for women who have anal sex. These are still in the early stages of trials, but certainly women are going to need both vaginal and rectal microbicides. A Tenofovir gel microbicide is now about to complete its phase III trial. If it proves to be successful, that is going to be our first microbicide in the market.

There is a large pool of population living with HIV/AIDS and they have their care needs and among them a common opportunistic infection is tuberculosis which leads to a lot of morbidity and mortality. We have the guidelines been drawn out but they require marriage between two departments right from the top it has to percolate to the grassroots and it requires a multilevel coordination right from the national to the sub district level to the village and point of person. Also the care and support systems are not increasing much in terms of infrastructure, staff capacity and most importantly there is need of sensitizing them against stigma and discrimination towards HIV patients. Then people will automatically try to access government services. In the private sector they are being exploited, given false promises and loose out a lot in the whole bargain. HIV and TB patients should be given simple health education whenever they come to a microscopy centre or ICTC about the signs and symptoms, when to approach, verbal screening at both the levels should be an ongoing process so that early case detection and management should also be one of the processes. Resource allocation to mitigate the dual infection HIV and TB should be given top priority. To effectively address TB-HIV co-infection at the district and sub-district level - include NGO DMCs with link ART centres (where ever applicable and as per the need) under PPP mode and include under the RNTCP-NACO joint schemes for effectively addressing the treatment adherence and completion rates among TB-HIV cases.

Governments, donors and other key institutions to do 5-6 major things. First there is still a lack of investment in terms of HIV treatment care support and prevention for MSM and transgenders. Secondly there is still inadequate service delivery. We need to persist governments and donors to increase the level of coverage significantly so that these populations can access these services. Third are is around lack of knowledge, strategic information that could support the development of these appropriate services and targeting of these services this strategic information not only includes the epidemiological data and behavioural data for many countries that I have but also psychosocial data as far as endemic issued are concerned such as the impact of stigma and discrimination, violence focussed on MSM and TG’s. Fourthly, we need to ensure that those affected members of MSM and TG communities are engaged in planning development and delivery of thee services. Fifthly there needs to be strong advocacy to reduce the levels stigma discrimination and social exclusion for MSM and TG’s. This means looking at the legal and policy environment. And where laws speak against them should be appealed. Where polices exist that discriminate access to services and health products these policies should be amended and changed.